Total and bone-specific alkaline phosphatases in haemodialysis patients with chronic liver disease

Gadrey, Jean; Souberbielle, Jean‐Claude; Zaoui, Éric; Lorriaux, Christie; Mayor, Brice; Hurot, Jean-Marc; Deleaval, Patrick; Chazot, Charles

doi:10.1016/j.clinbiochem.2012.01.018

Cited by 22 publications

(16 citation statements)

References 28 publications

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“…This can be related to differences in dialysis age in the two populations, as high PTH values can be regarded as a healthy response in young persons with low dialysis age, while a persisting high PTH would be considered as a lack of response and therefore a bad omen. Noteworthy, Atsumi et al also found that high t-ALP concentrations predicted fractures, and altogether t-ALP seems to be an easy accessible and cheap marker of bone loss in most populations (20), except for those with concomitant liver disease (19). Our results may however question the current recommendation of a PTH higher than the limit for healthy subjects in patients with CKD (18).…”

Section: Discussionmentioning

confidence: 99%

“…The recommended BTMs include total alkaline phosphatases (t-ALP) and bone-specific alkaline phosphatases (b-ALP), which in combination with serum parathyroid hormone (PTH) have been found useful for assessment of bone loss (15,18). Recently, a study of these BTM in HD patients could not confirm the use of b-ALP in patients with concomitant liver disease (19). The aim of the present study was to compare BMD of the femoral neck, forearm and spine in patients on HD and PD, respectively, and to identify BTMs in both type of dialysis patients.…”

Section: Introductionmentioning

confidence: 99%

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Determinants of bone mineral density in patients on haemodialysis or peritoneal dialysis – a cross-sectional, longitudinal study

et al. 2013

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Introduction:The aim of the study was to identify biomarkers of alteration in bone mineral density (BMD) in patients on haemodialysis (HD) and peritoneal dialysis (PD).Materials and methods:In a cross-sectional, longitudinal study dual-energy X-ray absorptiometry scans were performed in 146 HD-patients and 28 PD-patients. Follow-up after 14 months (mean) was conducted in 73 patients. As potential biomarkers we investigated parathyroid hormone (PTH), 25-hydroxy vitamin-D, ionised calcium, albumin, phosphate, and total alkaline phosphatases (t-ALP).Results:Both groups of dialysis patients had lower BMD in the femoral neck (BMDneck) (P < 0.001) and forearm (BMDforearm) (P < 0.001) compared to healthy controls, but comparable BMD in the lumbar spine (BMDspine). BMD did not differ between dialysis types, but patients ever-treated with glucocorticoids had significantly lower BMD, while patients with polycystic kidney disease had higher BMD. BMD correlated with body weight, actual age, age at initiation of dialysis, duration of dialysis and levels of PTH and t-ALP. However, t-ALP only remained associated with low BMDspine after adjusting for other factors (P = 0.001). In the follow-up study all patients had decreased BMD in all three locations, but only for the lumbar spine there was a significant association between BMD and the bone markers t-ALP (P = 0.009) and PTH (P = 0.013).Conclusions:Both HD and PD patients have low BMD, and increased concentrations of t-ALP is associated BMDspine after adjustment, while PTH and t-ALP is associated with decrease in BMDspine over time. This substantiates the use of these biomarkers in both types of dialysis patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Determinants of bone mineral density in patients on haemodialysis or peritoneal dialysis – a cross-sectional, longitudinal study

et al. 2013

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“…However, before BTMs can be widely used to manage renal bone disease, significant barriers need to be overcome. BSAP lacks a readily available automated assay, and there are concerns of cross‐reactivity with the liver iso‐enzyme, there are no validated reference ranges of BTMs in patients with CKD and ESKD, many BTMs are cleared by the kidney (monomeric P1NP, osteocalcin, and CTX) and BTMs have high intra‐ and interassay variability and biological variability …”

Section: Bone Turnover Markersmentioning

confidence: 99%

Rethinking Bone Disease in Kidney Disease

Damasiewicz

Nickolas

2018

JBMR Plus

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Renal osteodystrophy (ROD) is the bone component of chronic kidney disease mineral and bone disorder (CKD‐MBD). ROD affects bone quality and strength through the numerous hormonal and metabolic disturbances that occur in patients with kidney disease. Collectively these disorders in bone quality increase fracture risk in CKD patients compared with the general population. Fractures are a serious complication of kidney disease and are associated with higher morbidity and mortality compared with the general population. Furthermore, at a population level, fractures are at historically high levels in patients with end‐stage kidney disease (ESKD), whereas in contrast the general population has experienced a steady decline in fracture incidence rates. Based on these findings, it is clear that a paradigm shift is needed in our approach to diagnosing and managing ROD. In clinical practice, our ability to diagnose ROD and initiate antifracture treatments is impeded by the lack of accurate noninvasive methods that identify ROD type. The past decade has seen advances in the noninvasive measurement of bone quality and strength that have been studied in kidney disease patients. Below we review the current literature pertaining to the epidemiology, pathology, diagnosis, and management of ROD. We aim to highlight the pressing need for a greater awareness of this condition and the need for the implementation of strategies that prevent fractures in kidney disease patients. Research is needed for more accurate noninvasive assessment of ROD type, clinical studies of existing osteoporosis therapies in patients across the spectrum of kidney disease, and the development of CKD‐specific treatments. © 2018 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of the American Society for Bone and Mineral Research.

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“…In the setting of cholestatic liver disease with raised GGT, BSAP measurement will be required to ascertain the bone contribution to the raised ALP. In significant liver disease, the cross‐reactivity of BSAP with liver ALP can be up to 20%, thereby failing to add clarity . Nonetheless, some studies have found BSAP superior compared with total ALP and PTH in bone turnover determination .…”

Section: Kdigo Guidelinesmentioning

confidence: 99%

“…In significant liver disease, the cross‐reactivity of BSAP with liver ALP can be up to 20%, thereby failing to add clarity . Nonetheless, some studies have found BSAP superior compared with total ALP and PTH in bone turnover determination . ALP has a longer half‐life (1–2 days) compared to PTH (4 min) and has less day‐to day fluctuation.…”

Section: Kdigo Guidelinesmentioning

confidence: 99%

The use of bone turnover markers in chronic kidney disease‐mineral and bone disorders

Chiang

2017

Nephrology

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ABSTRACT:Bone turnover markers assist in fracture risk prediction, management and monitoring of osteoporosis in patients without chronic kidney disease (CKD). The use in CKD-mineral bone disorder (MBD) has been limited as many of these markers and breakdown products are renally excreted, including the most commonly used and well standardized procollagen type I N propeptide and C-terminal cross-linking telopeptide of type I collagen. Of the markers unaffected by renal function, bone specific alkaline phosphatase is associated with mortality and fracture rate in CKD subjects and is now available on several automated analysers. When used in combination with PTH, bone specific alkaline phosphatase as a bone formation marker correlated well with bone biopsy histomorphometry in predicting adynamic bone disease. Tartrate-resistant acid phosphatase 5b is a resorption marker that is under development for automation. Both high and low bone turnover in CKD-MBD patients are associated with increased fracture and mortality risk. Bone biopsy as the gold standard to differentiate between adynamic bone disease and osteitis fibrosa is limited by availability and cost. Appropriate use of bone turnover markers is vital in the decision to commence anti-resorptive agents, and to monitor efficacy in order to avoid over suppression of bone turnover, which may lead to stress fractures. Further efforts are required to develop markers unaffected by renal function with standardized cut-off values and fracture as well as vascular calcification end-points.

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Total and bone-specific alkaline phosphatases in haemodialysis patients with chronic liver disease

Cited by 22 publications

References 28 publications

Determinants of bone mineral density in patients on haemodialysis or peritoneal dialysis – a cross-sectional, longitudinal study

Determinants of bone mineral density in patients on haemodialysis or peritoneal dialysis – a cross-sectional, longitudinal study

Rethinking Bone Disease in Kidney Disease

The use of bone turnover markers in chronic kidney disease‐mineral and bone disorders

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